NGO\u1ea0I C\u01a0 S\u1ede: KH\u00c1M CH\u1ea4N TH\u01af\u01a0NG S\u1ecc N\u00c3O
\nlink down full b\u00e0i gi\u1ea3ng :http:\/\/adf.ly\/1ZWIR3<\/p>\n
KH\u00c1M CH\u1ea4N TH\u01af\u01a0NG S\u1ecc N\u00c3O<\/p>\n
A. H\u00c0NH CH\u00cdNH<\/p>\n
1. T\u00ean m\u00f4n h\u1ecdc: Ngo\u1ea1i b\u1ec7nh l\u00fd<\/p>\n
2. T\u00ean b\u00e0i gi\u1ea3ng: Kh\u00e1m ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o<\/p>\n
3. H\u00ecnh th\u1ee9c gi\u1ea3ng v\u00e0 b\u00e0i gi\u1ea3ng: L\u00fd thuy\u1ebft<\/p>\n
4. \u0110\u1ed1i t\u01b0\u1ee3ng: Y 3, CT2<\/p>\n
5. Th\u1eddi gian: 3 ti\u1ebft<\/p>\n
6. \u0110\u1ecba \u0111i\u1ec3m gi\u1ea3ng: Gi\u1ea3ng \u0111\u01b0\u1eddng<\/p>\n
7. Ng\u01b0\u1eddi bi\u00ean so\u1ea1n: Ths. L\u00ea Anh Tu\u1ea5n<\/p>\n
B. M\u1ee4C TI\u00caU<\/p>\n
1. Bi\u1ebft c\u00e1ch kh\u00e1m v\u00e0 theo d\u00f5i b\u1ec7nh nh\u00e2n b\u1ecb ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o<\/p>\n
2. Ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c m\u1ed9t tr\u01b0\u1eddng h\u1ee3p m\u00e1u t\u1ee5 n\u1ed9i s\u1ecd.<\/p>\n
C. N\u1ed8I DUNG H\u1eccC T\u1eacP<\/p>\n
I. \u0110\u1ea0I C\u01af\u01a0NG<\/p>\n
Ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o (CTSN) l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y ch\u1ebft, th\u01b0\u01a1ng t\u1eadt l\u00e2u d\u00e0i cho<\/p>\n
ng\u01b0\u1eddi d\u01b0\u1edbi 40 tu\u1ed5i tr\u00ean to\u00e0n th\u1ebf gi\u1edbi. T\u1ef7 l\u1ec7 t\u1eeb vong \u1edf CTSN lo\u1ea1i trung b\u00ecnh l\u00e0 4% – 8%,<\/p>\n
50% \u1edf CTSN n\u1eb7ng.<\/p>\n
N\u0103m 1999 Khoa c\u1ea5p c\u1ee9u b\u1ec7nh vi\u1ec7n Ch\u1ee3 R\u1eaby nh\u1eadn \u0111i\u1ec1u tr\u1ecb 64.129 b\u1ec7nh nh\u00e2n trong<\/p>\n
\u0111\u00f3 c\u00f3 48.590 b\u1ec7nh nh\u00e2n thu\u1ed9c kh\u1ed1i Ngo\u1ea1i (t\u1ed5ng qu\u00e1t, l\u1ed3ng ng\u1ef1c, ch\u1ec9nh h\u00ecnh, r\u0103ng, \u2026) v\u00e0<\/p>\n
35.761 b\u1ec7nh nh\u00e2n \u0111\u1ebfn v\u00ec ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o.<\/p>\n
V\u1edbi c\u00e1c con s\u1ed1 n\u00e0y ta th\u1ea5y ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o chi\u1ebfm t\u1ec9 l\u1ec7 r\u1ea5t cao trong c\u1ea5p c\u1ee9u \u1edf<\/p>\n
B\u1ec7nh vi\u1ec7n Ch\u1ee3 R\u1eaby. C\u00f3 th\u1ec3 gi\u1ea3i th\u00edch l\u00fd do l\u00e0 vi\u1ec7c t\u1ed5 ch\u1ee9c \u0111i\u1ec1u tr\u1ecb ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o \u1edf<\/p>\n
c\u00e1c b\u1ec7nh vi\u1ec7n Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh v\u00e0 c\u00e1c t\u1ec9nh ph\u00eda Nam ch\u01b0a h\u1ee3p l\u00fd, c\u00e1c b\u1ec7nh nh\u00e2n<\/p>\n
b\u1ecb ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o th\u01b0\u1eddng \u0111\u1ed5 d\u1ed3n v\u1ec1 Ch\u1ee3 R\u1eaby.<\/p>\n
Chi\u1ebfn l\u01b0\u1ee3c h\u1ea1 th\u1ea5p t\u1ec9 l\u1ec7 t\u1eed vong v\u00e0 di ch\u1ee9ng c\u1ee7a ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o l\u00e0 s\u1ef1 th\u00fac \u0111\u1ea9y<\/p>\n
x\u00e2y d\u1ef1ng m\u1ea1ng l\u01b0\u1edbi \u0111i\u1ec1u tr\u1ecb ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o \u1edf c\u00e1c \u0111\u1ecba ph\u01b0\u01a1ng sao cho th\u00edch h\u1ee3p.<\/p>\n
Ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o c\u00f3 th\u1ec3 k\u00e8m v\u1edbi c\u00e1c th\u01b0\u01a1ng t\u1ed5n kh\u00e1c nh\u01b0: Tr\u00e0n m\u00e1u, tr\u00e0n kh\u00ed \u1edf ph\u1ed5i,<\/p>\n
d\u1eadp ph\u1ed5i, xu\u1ea5t huy\u1ebft n\u1ed9i, v\u1ee1 t\u1ea1ng r\u1ed7ng, g\u00e3y x\u01b0\u01a1ng s\u1ed1ng, g\u00e3y c\u00e1c x\u01b0\u01a1ng trong c\u01a1 th\u1ec3.<\/p>\n
Ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o th\u01b0\u1eddng g\u00e2y ra c\u00e1c t\u1ed5n th\u01b0\u01a1ng nguy hi\u1ec3m nh\u01b0 m\u00e1u t\u1ee5 trong s\u1ecd,<\/p>\n
vi\u00eam m\u00e0ng n\u00e3o. V\u00ec v\u1eady kh\u00e1m ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o c\u1ea7n:<\/p>\n
\uf02d Kh\u00e1m to\u00e0n di\u1ec7n.<\/p>\n
\uf02d Ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1edbm c\u00e1c th\u01b0\u01a1ng t\u1ed5n k\u1ec3 tr\u00ean, d\u1ec5 gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong v\u00e0 c\u00e1c d\u01b0<\/p>\n
ch\u1ee9ng n\u1eb7ng. 56 \u2013 60% b\u1ec7nh nh\u00e2n ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o c\u00f3 m\u1ed9t \u2013 nhi\u1ec1u th\u01b0\u01a1ng t\u1ed5n \u1edf c\u01a1<\/p>\n
quan ngo\u00e0i s\u1ecd n\u00e3o, v\u1edbi 25% th\u01b0\u01a1ng t\u1ed5n c\u1ea7n ph\u1ea9u thu\u1eadt, 4 – 5% c\u00f3 th\u01b0\u01a1ng t\u1ed5n c\u1ed9t s\u1ed1ng,<\/p>\n
ph\u1ea7n l\u1edbn \u1edf C 1 \u2013 C 3 .<\/p>\n
* Th\u01b0\u01a1ng t\u1ed5n n\u00e3o th\u01b0\u1eddng c\u00f3 hai lo\u1ea1i<\/p>\n
+ Nguy\u00ean ph\u00e1t: Do \u0111\u1ee5ng \u0111\u1eadp tr\u1ef1c ti\u1ebfp g\u00e2y t\u1ed5n th\u01b0\u01a1ng \u0111\u1eadp r\u00e1ch v\u1ecf n\u00e3o, n\u1ee9t l\u00fan s\u1ecd,<\/p>\n
th\u01b0\u01a1ng t\u1ed5n lan t\u1ecfa theo tr\u1ee5c d\u1eadp th\u00e2n n\u00e3o.<\/p>\n
+ Th\u1ee9 ph\u00e1t: H\u1eadu qu\u1ea3 c\u1ee7a s\u1ef1 ph\u00e1t tri\u1ec3n th\u01b0\u01a1ng t\u1ed5n nguy\u00ean ph\u00e1t: c\u00e1c lo\u1ea1i m\u00e1u t\u1ee5 trong<\/p>\n
s\u1ecd, ph\u00f9 n\u00e3o thi\u1ebfu oxy, thi\u1ebfu m\u00e1u n\u00e3o.<\/p>\n
Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb c\u00e1c th\u01b0\u01a1ng t\u1ed5n n\u00e0y c\u1ea7n c\u00f3 ki\u1ebfn th\u1ee9c n\u1ed9i khoa t\u1ed5ng qu\u00e1t v\u00e0 s\u1ef1 hi\u1ec3u bi\u1ebft<\/p>\n
r\u00f5 v\u1ec1 t\u0103ng \u00e1p l\u1ef1c trong s\u1ecd.<\/p>\n
C\u00e1c th\u01b0\u01a1ng t\u1ed5n th\u1ee9 ph\u00e1t g\u00e2y t\u1ed5n th\u01b0\u01a1ng n\u00e3o theo c\u01a1 ch\u1ebf sau:<\/p>\n
H\u1ea1 huy\u1ebft \u00e1p Thi\u1ebfu oxy<\/p>\n
Gi\u1ea3m l\u01b0\u1ee3ng t\u01b0\u1edbi m\u00e1u n\u00e3o Thay \u0111\u1ed5i bi\u1ebfn d\u01b0\u1ee1ng<\/p>\n
T\u1ed5n th\u01b0\u01a1ng c\u00e1c vi m\u1ea1ch M\u00e0ng t\u1ebf b\u00e0o b\u1ecb ph\u00e1 v\u1ee1<\/p>\n
T\u1ebf b\u00e0o n\u00e3o: ho\u1ea1i t\u1eed ch\u1ebft T\u1ebf b\u00e0o n\u00e3o: thi\u1ebfu oxy-ch\u1ebft<\/p>\n
T\u0103ng: t\u1eed vong v\u00e0 di ch\u1ee9ng<\/p>\n
C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 \u1edf b\u1ec7nh nh\u00e2n CTSN:<\/p>\n
\uf02d GCS <15 \u0111i\u1ec3m k\u00e9o d\u00e0i h\u01a1n 2 gi\u1edd sau CTSN.<\/p>\n
\uf02d Qu\u00ean k\u00e9o d\u00e0i c\u00e1c vi\u1ec7c x\u1ea3y ra sau CTSN.<\/p>\n
\uf02d Qu\u00ean h\u01a1n 30 ph\u00fat c\u00e1c vi\u1ec7c x\u1ea3y ra tr\u01b0\u1edbc khi CTSN.<\/p>\n
\uf02d C\u00f3 d\u1ea5u hi\u1ec7n: n\u1ee9t \u2013 l\u00fan s\u1ecd, n\u1ee9t s\u00e0n s\u1ecd.<\/p>\n
\uf02d Nh\u1ee9c \u0111\u1ea7u d\u1eef d\u1ed9i.<\/p>\n
< 2 tu\u1ed5i;<\/p>\n
> 60 tu\u1ed5i;<\/p>\n
\uf02d R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u.<\/p>\n
\uf02d C\u00f3 c\u01a1 ch\u1ebf b\u1ecb CTSN m\u1ea1nh.<\/p>\n
\uf02d C\u00f3 d\u1ea5u hi\u1ec7u ng\u1ed9 \u0111\u1ed9c r\u01b0\u1ee3u – \u0111\u1ed9c ch\u1ea5t.<\/p>\n
\u0110\u1ec3 tr\u00e1nh c\u00e1c h\u1eadu qu\u1ea3 khi v\u1eadn chuy\u1ec3n b\u1ec7nh nh\u00e2n ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o c\u1ea7n \u0111\u00e1nh gi\u00e1 v\u00e0<\/p>\n
\u0111i\u1ec1u ch\u1ec9nh c\u00e1c y\u1ebfu t\u1ed1 theo b\u1ea3ng 1-1.<\/p>\n
B\u1ea3ng 1-1: C\u00e1c y\u1ebfu t\u1ed1 c\u1ea7n quan t\u00e2m khi<\/p>\n
di chuy\u1ec3n b\u1ec7nh nh\u00e2n ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o<\/p>\n
D\u1ea4U HI\u1ec6U L\u00c2M S\u00c0NG<\/p>\n
C\u1ea6N CH\u00da \u00dd<\/p>\n
C\u00c1C Y\u1ebeU T\u1ed0<\/p>\n
C\u1ea6N KI\u1ec2M TRA C\u00c1C B\u01af\u1edaC \u0110I\u1ec0U TR\u1eca<\/p>\n
– Kh\u00ed m\u00e1u<\/p>\n
– Nh\u1ecbp th\u1edf<\/p>\n
– \u0110o huy\u1ebft \u00e1p<\/p>\n
– Hgb, Hct<\/p>\n
– \u0110\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n cho b\u1ec7nh nh\u00e2n c\u00f3<\/p>\n
t\u0103ng CO 2 , h\u1ea1 O 2<\/p>\n
Truy\u1ec1n m\u00e1u khi c\u00f3 \u0111\u1ea5u hi\u1ec7u m\u1ea5t m\u00e1u.<\/p>\n
– \u0110\u1ed9ng kinh – \u0110o c\u00e1c \u0111i\u1ec7n gi\u1ea3i – \u0110i\u1ec1u ch\u1ec9nh natri, \u0111\u01b0\u1eddng, \u2026<\/p>\n
– C\u00f4ng th\u1ee9c b\u1ea1ch c\u1ea7u<\/p>\n
– Nhi\u1ec7t \u0111\u1ed9<\/p>\n
– S\u1ef1 v\u1eefng ch\u1eafc c\u1ed9t s\u1ed1ng – Ch\u1ee5p X_Quang – N\u1ebfu c\u1ea7n: C\u1ed1 \u0111\u1ecbnh c\u1ed9t s\u1ed1ng (v\u00f2ng c\u1ed1<\/p>\n
– Cho c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u1ed9ng kinh.<\/p>\n
– Ch\u1ecdc d\u00f2 d\u1ecbch n\u00e3o t\u1ee7y n\u1ebfu c\u00f3 d\u1ea5u hi\u1ec7u<\/p>\n
vi\u00eam m\u00e0ng n\u00e3o, v\u00e0 kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9<\/p>\n
\u0111\u1ecbnh.<\/p>\n
\u0111\u1ecbnh c\u1ed9t s\u1ed1ng c\u1ed5, v\u00e1n c\u1ed1 \u0111\u1ecbnh c\u1ed9t s\u1ed1ng<\/p>\n
ng\u1ef1c l\u01b0ng \u2026)<\/p>\n
II. KH\u00c1M CH\u1ea4N TH\u01af\u01a0NG S\u1ecc N\u00c3O<\/p>\n
Kh\u00e1m ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o c\u1ea7n theo d\u00f5i th\u01b0\u1eddng xuy\u00ean v\u00e0 \u0111\u1ec1u \u0111\u1eb7n \u0111\u1ec3<\/p>\n
ph\u00e1t hi\u1ec7n c\u00e1c th\u01b0\u01a1ng t\u1ed5n xu\u1ea5t hi\u1ec7n \u0111\u1eb7c bi\u1ec7t l\u00e0 d\u1ea5u hi\u1ec7u tri gi\u00e1c v\u00e0 d\u1ea5u th\u1ea7n<\/p>\n
2.1. KH\u00c1M T\u00ccNH TR\u1ea0NG CHUNG<\/p>\n
* C\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng<\/p>\n
\uf02d Nguy\u00ean nh\u00e2n g\u00e2y ra tai n\u1ea1n<\/p>\n
\uf02d Ho\u00e0n c\u1ea3nh n\u01a1i x\u1ea3y ra tai n\u1ea1n<\/p>\n
* T\u00ecnh h\u00ecnh v\u00e0 di\u1ec5n ti\u1ebfn c\u1ee7a b\u1ec7nh nh\u00e2n t\u1eeb k\u00fac b\u1ecb ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o \u0111\u1ebfn l\u00fac<\/p>\n
\uf02d B\u00ean c\u1ea1nh c\u00f3 kho\u1ea3ng t\u1ec9nh hay kh\u00f4ng?<\/p>\n
\uf02d C\u00f3 k\u00e8m c\u00e1c th\u01b0\u01a1ng t\u1ed5n \u1edf c\u00e1c c\u01a1 quan kh\u00e1c?<\/p>\n
2.2. L\u00c2M S\u00c0NG V\u00c0 T\u1ed4NG QU\u00c1T<\/p>\n
2.2.1. Quan s\u00e1t h\u1ed9p s\u1ecd<\/p>\n
* D\u1ea5u hi\u1ec7u v\u1ee1 s\u00e0n s\u1ecd:<\/p>\n
\uf02d D\u1ea5u hi\u1ec7u k\u00ednh r\u00e2m (m\u1eaft g\u1ea5u tr\u00fac).<\/p>\n
\uf02d D\u1ea5u hi\u1ec7u b\u1ea7m m\u00e1u sau tai: Battle.<\/p>\n
\uf02d Ch\u1ea3y d\u1ecbch n\u00e3o t\u1ee7y tai \u2013 m\u0169i<\/p>\n
\uf02d T\u1ee5 m\u00e1u m\u00e0ng nh\u0129, r\u00e1ch \u1ed1ng tai ngo\u00e0i.<\/p>\n
2.2.2. V\u1ee1 x\u01b0\u01a1ng m\u1eb7t<\/p>\n
\uf02d G\u00e3y Lefort: T\u00ecm \u0111i\u1ec3m \u0111au x\u01b0\u01a1ng m\u1eb7t, cung g\u00f2 m\u00e1.<\/p>\n
\uf02d G\u00e3y b\u1edd h\u1ed1c m\u1eaft.<\/p>\n
2.2.3. Ph\u00f9 n\u1ec1 quanh h\u1ed1c m\u1eaft, l\u1ed3i m\u1eaft<\/p>\n
\uf02d M\u1ea1ch ch\u1eadm d\u1ea7n<\/p>\n
\uf02d Huy\u1ebft \u00e1p t\u0103ng d\u1ea7n<\/p>\n
\uf02d Nhi\u1ec7t \u0111\u1ed9 t\u0103ng d\u1ea7n<\/p>\n
\uf02d Nh\u1ecbp th\u1edf: nhanh ho\u1eb7c r\u1ed1i lo\u1ea1n, \u1edf giai \u0111o\u1ea1n n\u1eb7ng nh\u1ecbp th\u1edf ch\u1eadm (Theo Cushing).<\/p>\n
2.4. D\u1ea4U HI\u1ec6U TH\u1ea6N KINH<\/p>\n
2.4.1. D\u1ea5u hi\u1ec7u m\u00e0ng n\u00e3o<\/p>\n
C\u00f3 \u1edf b\u1ec7nh nh\u00e2n b\u1ecb vi\u00eam m\u00e0ng n\u00e3o v\u00ec c\u00f3 v\u1ebft th\u01b0\u01a1ng s\u1ecd n\u00e3o \u0111\u1ebfn tr\u1ec5 ho\u1eb7c \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb<\/p>\n
B\u1ec7nh nh\u00e2n b\u1ecb xu\u1ea5t huy\u1ebft d\u01b0\u1edbi m\u00e0ng nh\u1ec7n th\u01b0\u1eddng c\u00f3 d\u1ea5u m\u00e0ng n\u00e3o. C\u1ea7n cho b\u1ec7nh<\/p>\n
nh\u00e2n nh\u1eadp vi\u1ec7n \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n xem c\u00f3 v\u1ee1 d\u1ecb d\u1ea1ng m\u1ea1ch m\u00e1u n\u00e3o.<\/p>\n
2.4.2. Th\u1ea7n kinh th\u1ecb gi\u00e1c<\/p>\n
\uf02d B\u1ec7nh nh\u00e2n t\u1ec9nh: Xem b\u1ec7nh c\u00f3 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c \u0111\u1ecdc ch\u1eef in, \u0111\u1ebfm ng\u00f3n tay, th\u1ea5y c\u1eed<\/p>\n
\u0111\u1ed9ng tay, nh\u1eadn bi\u1ebft \u00e1nh s\u00e1ng.<\/p>\n
Tr\u1ebb em c\u00f3 th\u1ec3 m\u00f9 v\u1ecf n\u00e3o 1 – 2 ng\u00e0y sau ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o v\u00f9ng ch\u1ea9m.<\/p>\n
\uf02d B\u1ec7nh nh\u00e2n m\u00ea: Xem \u0111\u1ed3ng t\u1eed ph\u1ea3n x\u1ea1 v\u1edbi \u00e1nh s\u00e1ng.<\/p>\n
\uf02d \u0110\u1ed3ng t\u1eed: D\u1ea5u d\u00e3n \u0111\u1ed3ng t\u1eed: l\u00e0 d\u1ea5u hi\u1ec7u quan tr\u1ecdng: \u0110\u1ed3ng t\u1eed d\u00e3n d\u1ea7n do m\u00e1u t\u1ee5 l\u1edbn<\/p>\n
d\u00e0n g\u00e2y t\u1ee5t n\u00e3o h\u1ed3i h\u1ea3i m\u00e3 th\u00f9y th\u00e1i d\u01b0\u01a1ng, \u0111\u1ed3ng t\u1eed th\u01b0\u1eddng gi\u00e3n v\u00e0 m\u1ea5t ph\u1ea3n x\u1ea1 \u00e1nh s\u00e1ng<\/p>\n
c\u00f9ng b\u00ean v\u1edbi kh\u1ed1i m\u00e1u t\u1ee5. Tuy nhi\u00ean n\u1ebfu \u0111\u1ed3ng t\u1eed gi\u00e3n ngay sau khi ch\u1ea5n th\u01b0\u01a1ng th\u00ec ph\u1ea3i<\/p>\n
xem c\u00f3 ch\u1ea5n th\u01b0\u01a1ng tr\u1ef1c ti\u1ebfp v\u00e0o m\u1eaft l\u00e0m d\u00e2y III t\u1ed5n th\u01b0\u01a1ng g\u00e2y gi\u00e3n \u0111\u1ed3ng t\u1eed hay<\/p>\n
kh\u00f4ng? Tr\u01b0\u1eddng h\u1ee3p n\u00e0y kh\u00f4ng c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n m\u00e1u t\u1ee5 trong s\u1ecd.<\/p>\n
2.4.3. D\u00e2y VII: Xem c\u00f3 d\u1ea5u hi\u1ec7u li\u1ec7t th\u1ea7n kinh VII ngo\u1ea1i bi\u00ean.<\/p>\n
2.4.4. \u0110\u00e1y m\u1eaft: Ph\u00f9, xu\u1ea5t huy\u1ebft tr\u01b0\u1edbc v\u00f5ng m\u1ea1c, b\u00f3c t\u00e1ch v\u00f5ng m\u1ea1c, t\u1ed5n th\u01b0\u01a1ng v\u00f5ng<\/p>\n
2.5. KH\u00c1M TRI GI\u00c1C<\/p>\n
\u0110\u1ec3 tr\u00e1nh t\u00ecnh tr\u1ea1ng tri gi\u00e1c b\u1ec7nh nh\u00e2n t\u1ed1t hay x\u1ea5u d\u1ea7n ta d\u00f9ng b\u1ea3ng GLASGOW<\/p>\n
\uf02d M\u1edf m\u1eaft (Eye Opening)<\/p>\n
+T\u1ef1 nhi\u00ean E. 4<\/p>\n
+ V\u1edbi ti\u1ebfng \u0111\u1ed9ng 3<\/p>\n
+ V\u1edbi k\u00edch th\u00edch \u0111au 2<\/p>\n
+ Kh\u00f4ng 1<\/p>\n
\uf02d V\u1eadn \u0111\u1ed9ng (Motor Response)<\/p>\n
+ Theo y\u00eau c\u1ea7u: t\u1ed1t M. 6<\/p>\n
+ Ph\u1ea3n \u1ee9ng khi k\u00edch th\u00edch \u0111au:<\/p>\n
\uf0b7 Ch\u00ednh x\u00e1c 5<\/p>\n
\uf0b7 Kh\u00f4ng ch\u00ednh x\u00e1c 4<\/p>\n
+ G\u1eadp t\u1ee9 chi 3<\/p>\n
+ Du\u1ed7i t\u1ee9 chi 2<\/p>\n
+ Kh\u00f4ng 1<\/p>\n
\uf02d L\u1eddi n\u00f3i (Verbal Response)<\/p>\n
+ Tr\u1ea3 l\u1eddi: t\u1ed1t V. 5<\/p>\n
+ Tr\u1ea3 l\u1eddi nh\u1ea7m l\u1eabn 4<\/p>\n
+ N\u00f3i c\u00e1c ch\u1eef v\u00f4 ngh\u0129a 3<\/p>\n
+ N\u00f3i kh\u00f4ng th\u00e0nh ti\u1ebfng 2<\/p>\n
+ Kh\u00f4ng 1<\/p>\n
Thang \u0111i\u1ec3m Glasgow c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 theo nh\u1eefng kho\u1ea3ng c\u00e1ch th\u1eddi gian \u0111\u1ec3 xem<\/p>\n
tri gi\u00e1c b\u1ec7nh nh\u00e2n t\u1ed1t d\u1ea7n hay x\u1ea5u d\u1ea7n.M\u1ed7i l\u1ea7n \u0111\u00e1nh gi\u00e1 c\u1ea7n ghi t\u1ed5ng s\u1ed1 \u0111i\u1ec3m v\u00e0 m\u1ed7i y\u1ebfu<\/p>\n
t\u1ed1 l\u00e0 bao nhi\u00eau \u0111\u1ec3 d\u1ec5 theo d\u00f5i s\u1ef1 chuy\u1ec3n bi\u1ebfn c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n
Th\u00ed d\u1ee5: Glasgow 10 \u0111i\u1ec3m.<\/p>\n
\uf02d M\u1edf m\u1eaft: 2<\/p>\n
\uf02d V\u1eadn \u0111\u1ed9ng: 4<\/p>\n
\uf02d L\u1eddi n\u00f3i: 4<\/p>\n
Kho\u1ea3ng t\u1ec9nh th\u01b0\u1eddng c\u00f3 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb m\u00e1u t\u1ee5 ngo\u00e0i m\u00e0ng c\u1ee9ng.<\/p>\n
2.6. KH\u00c1M V\u1eacN D\u1ed8NG<\/p>\n
\uf02d B\u1ec7nh nh\u00e2n h\u1ee3p t\u00e1c: Xem s\u1ee9c c\u01a1 \u2013 tr\u01b0\u1eddng l\u1ef1c co 4 chi.<\/p>\n
\uf02d B\u1ec7nh nh\u00e2n kh\u00f4ng h\u1ee3p t\u00e1c: Xem \u0111\u00e1p \u1ee9ng c\u1ee7a 4 chi v\u1edbi k\u00edch th\u00edch \u0111au (c\u1ea7n ph\u00e2n bi\u1ec7t<\/p>\n
ph\u1ea3n x\u1ea1 t\u1ef1 \u0111\u1ed9ng t\u1ee7y).<\/p>\n
\uf02d N\u1ebfu nghi ng\u1edd t\u1ed5n th\u01b0\u01a1ng t\u1ee7y s\u1ed1ng c\u1ea7n kh\u00e1m s\u1ee9c co c\u1ee7a c\u01a1 v\u00f2ng h\u1eadu m\u00f4n, ph\u1ea3n x\u1ea1<\/p>\n
h\u00e0nh hang, n\u1ebfp nh\u0103n h\u1eadu m\u00f4n.<\/p>\n
\uf02d Y\u1ebfu li\u1ec7t n\u1eeda ng\u01b0\u1eddi: Khi b\u1ec7nh nh\u00e2n gi\u00e3y d\u1ee5a ho\u1eb7c kh\u00e1ng c\u1ef1 v\u1edbi k\u00edch th\u00edch \u0111au, tay<\/p>\n
ch\u00e2n b\u00ean y\u1ebfu li\u1ec7t s\u1ebd c\u1eed \u0111\u1ed9ng \u00edt ho\u1eb7c kh\u00f4ng c\u00f3 so v\u1edbi b\u00ean \u0111\u1ed1i di\u1ec7n.<\/p>\n
2.7. KHAM C\u1ea2M GI\u00c1C<\/p>\n
\uf02d B\u1ec7nh nh\u00e2n ph\u1ed1i h\u1ee3p: Xem \u0111\u00e1p \u1ee9ng c\u1ee7a c\u1ea3m gi\u00e1c kim ch\u00e2m \u1edf c\u00e1c khoanh c\u1ea3m gi\u00e1c<\/p>\n
(C4 \u2013 x\u01b0\u01a1ng c\u00f9ng).<\/p>\n
\uf02d B\u1ec7nh nh\u00e2n kh\u00f4ng ph\u1ed1i h\u1ee3p:<\/p>\n
\uf02b Xem d\u1ea5u hi\u1ec7u li\u1ec7t m\u1eb7t Pierre Marie v\u00e0 Foix.<\/p>\n
2.8. KH\u00c1M PH\u1ea2N X\u1ea0<\/p>\n
\uf02d G\u00e2n x\u01b0\u01a1ng, da b\u1ee5ng, da b\u00ecu<\/p>\n
\uf02d C\u00e1c ph\u1ea3n x\u1ea1 h\u1eadu m\u00f4n n\u1ebfu c\u00f3 nghi ng\u1edd t\u1ed5n th\u01b0\u01a1ng t\u1ee7y s\u1ed1ng.<\/p>\n
2.9. D\u1ea4U HI\u1ec6U TI\u1ec2U N\u00c3O<\/p>\n
D\u1ea5u hi\u1ec7u rung gi\u1eadt nh\u00e3n c\u1ea7u th\u01b0\u1eddng g\u1eb7p \u1edf tr\u1ebb em b\u1ecb m\u00e1u t\u1ee5 h\u1ed1 sau.<\/p>\n
III. X\u00c9T NGHI\u1ec6M C\u1eacN L\u00c2M S\u00c0NG<\/p>\n
3.1. X_QUANG S\u1ecc N\u00c3O: c\u00f3 ch\u1ec9 \u0111\u1ecbnh khi:<\/p>\n
\uf02d B\u1ec7nh nh\u00e2n c\u00f3 b\u1ea5t t\u1ec9nh sau ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o<\/p>\n
\uf02d Nghi v\u1ee1 s\u00e0n s\u1ecd<\/p>\n
\uf02d T\u1ee5 m\u00e1u d\u01b0\u1edbi da \u0111\u1ea7u<\/p>\n
\uf02d B\u1ec7nh nh\u00e2n b\u1ecb \u0111\u1eadp v\u1eadt nh\u1ecdn v\u00e0o \u0111\u1ea7u, nh\u1ea5t l\u00e0 \u1edf tr\u1ebb em x\u01b0\u01a1ng s\u1ecd m\u1ecfng, v\u1eadt nh\u1ecdn c\u00f3 th\u1ec3<\/p>\n
xuy\u00ean th\u1ee7ng x\u01b0\u01a1ng s\u1ecd m\u00e0ng c\u1ee9ng n\u00e3o<\/p>\n
3.2. CH\u1ee4P N\u00c3O C\u1eaeT L\u1edaP (Computerized tomography): \u0110\u00e2y l\u00e0 x\u00e9t nghi\u1ec7m c\u01a1<\/p>\n
b\u1ea3n nh\u1ea5t trong ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o, cho ph\u00e9p ch\u1ea9n \u0111o\u00e1n nhanh, ch\u00ednh x\u00e1c kh\u00f4ng l\u00e0m<\/p>\n
nguy hi\u1ec3m th\u00eam cho b\u1ec7nh nh\u00e2n.<\/p>\n
*Ch\u1ee5p n\u00e3o c\u1eaft l\u1edbp cho th\u1ea5y c\u00e1c th\u01b0\u01a1ng t\u1ed5n sau:<\/p>\n
\uf02d M\u00e1u t\u1ee5: Ngo\u00e0i m\u00e0ng c\u1ee9ng, d\u01b0\u1edbi m\u00e0ng c\u1ee9ng, trong nhu m\u00f4 n\u00e3o, trong n\u00e3o th\u1ea5t, d\u01b0\u1edbi<\/p>\n
\uf02d \u0110\u1ea7u n\u01b0\u1edbc sau ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o<\/p>\n
\uf02d N\u00e3o thi\u1ebfu Oxy, thi\u1ebfu m\u00e1u nu\u00f4i g\u00e2y ho\u1ea1i t\u1eed n\u00e3o<\/p>\n
\uf02d H\u01a1i trong s\u1ecd<\/p>\n
\uf02d V\u1ee1 x\u01b0\u01a1ng s\u1ecd, k\u1ec3 c\u1ea3 v\u1ee1 s\u00e0n s\u1ecd<\/p>\n
\uf02d Di l\u1ec7ch c\u1ea5u tr\u00fac \u0111\u01b0\u1eddng gi\u1eefa trong h\u1ed9p s\u1ecd, s\u1ef1 di l\u1ec7ch n\u00e0y li\u00ean quan t\u1edbi s\u1ef1 gi\u1ea3m tri<\/p>\n
gi\u00e1c c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n
* Ch\u1ec9 \u0111\u1ecbnh ch\u1ee5p n\u00e3o c\u1eaft l\u1edbp:<\/p>\n
\uf02d C\u00e1c b\u1ec7nh nh\u00e2n ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 trung b\u00ecnh, n\u1eb7ng c\u00f3 d\u1ea5u n\u1ee9t s\u1ecd tr\u00ean<\/p>\n
phim s\u1ecd th\u01b0\u1eddng, c\u00f3 d\u1ea5u hi\u1ec7u khu tr\u00fa,tri gi\u00e1c gi\u1ea3m, gi\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n sau ch\u1ea5n th\u01b0\u01a1ng s\u1ecd<\/p>\n
\uf02d B\u1ec7nh nh\u00e2n c\u1ea7n g\u00e2y m\u00ea \u0111\u1ec3 l\u00e0m c\u00e1c th\u1ee7 thu\u1eadt, m\u00e0 ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o c\u1ea7n ph\u1ea3i theo<\/p>\n
\uf02d B\u1ec7nh nh\u00e2n ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o n\u1eb7ng \u0111\u00e3 \u1ed5n \u0111\u1ecbnh c\u1ea7n ch\u1ee5p n\u00e3o c\u1eaft l\u1edbp l\u1ea7n th\u1ee9 hai t\u1eeb<\/p>\n
ng\u00e0y th\u1ee9 3 \u0111\u1ebfn th\u1ee9 5, v\u00e0 l\u1ea7n th\u1ee9 ba \u1edf ng\u00e0y th\u1ee9 10 – 15 k\u1ec3 t\u1eeb l\u1ea7n ch\u1ee5p \u0111\u1ea7u ti\u00ean.<\/p>\n
\uf02d C\u00e1c ch\u1ec9 \u0111\u1ecbnh ch\u1ee5p n\u00e3o c\u1eaft l\u1edbp t\u00f9y thu\u1ed9c v\u00e0o l\u00e2m s\u00e0ng v\u00e0 s\u1ed1 ch\u1ec9 \u00e1p l\u1ef1c trong s\u1ecd.<\/p>\n
3.3. CH\u1ee4P C\u1ed8T S\u1ed0NG<\/p>\n
\uf02d C\u1ed9t s\u1ed1ng c\u1ed5: C\u1ea7n ch\u1ee5p v\u00e0 \u0111eo n\u1eb9p c\u1ed5 n\u1ebfu ch\u01b0a lo\u1ea1i tr\u1eeb t\u1ed5n th\u01b0\u01a1ng c\u1ed9t s\u1ed1ng, t\u1ee7y s\u1ed1ng<\/p>\n
\uf02d C\u1ed9t s\u1ed1ng ng\u1ef1c l\u01b0ng: T\u00f9y theo c\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng v\u00e0 d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng.<\/p>\n
3.4. C\u1ed8NG H\u01af\u1edeNG T\u1eea NHAN ( M.R.I): \u00edt d\u00f9ng trong c\u1ea5p c\u1ee9u.<\/p>\n
3.5. SI\u00caU \u00c2M<\/p>\n
\uf02d Mode A: C\u00f2n c\u00f3 gi\u00e1 tr\u1ecb trong ch\u1ea9n \u0111o\u00e1n m\u00e1u t\u1ee5 d\u00f9 r\u1ea5t h\u1ea1n ch\u1ebf.<\/p>\n
\uf02d Mode B: C\u00f2n gi\u00e1 tr\u1ecb trong ch\u1ea9n \u0111o\u00e1n ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o \u1edf l\u1ee9a tu\u1ed5i c\u00f2n th\u00f3p.<\/p>\n
3.6. M\u1ea0CH N\u00c3O D\u1ed2 (Cerebral angiography): ng\u00e0y nay \u00edt d\u00f9ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n kh\u1ed1i<\/p>\n
cho\u00e1n ch\u1ed7 trong h\u1ed9p s\u1ecd, n\u00f3 th\u01b0\u1eddng \u0111\u01b0\u1ee3c d\u00f9ng trong c\u00e1c th\u1ee7 thu\u1eadt ch\u1ea9n \u0111o\u00e1n b\u1ec7nh l\u00fd<\/p>\n
m\u1ea1ch m\u00e1u n\u00e3o, stereotaxy.<\/p>\n
3.7. \u0110O \u00c1P L\u1ef0C TRONG S\u1ecc (Intracranial pressure): \u0110\u00e2y l\u00e0 m\u1ed9t x\u00e9t nghi\u1ec7m r\u1ea5t<\/p>\n
quan tr\u1ecdng trong vi\u1ec7c theo d\u00f5i \u00e1p l\u1ef1c trong s\u1ecd c\u1ee7a b\u1ec7nh nh\u00e2n b\u1ecb ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o. \u00c1p<\/p>\n
l\u1ef1c \u0111\u01b0\u1ee3c \u0111o \u1edf trong n\u00e3o th\u1ea5t,d\u01b0\u1edbi m\u00e0ng c\u1ee9ng, c\u00e1c ch\u1ec9 s\u1ed1 \u1edf c\u00e1c v\u1ecb tr\u00ed \u0111\u00f3 \u0111\u1ec1u c\u00f3 gi\u00e1 tr\u1ecb nh\u01b0<\/p>\n
B\u1ea3ng 3-1. Tr\u1ecb s\u1ed1 \u00e1p l\u1ef1c trong s\u1ecd<\/p>\n
L\u1ee9a tu\u1ed5i \u00c1p l\u1ef1c n\u1ed9i s\u1ecd b\u00ecnh th\u01b0\u1eddng<\/p>\n
Ng\u01b0\u1eddi l\u1edbn v\u00e0 tr\u1ebb > 10 tu\u1ed5i 10 \u2013 15mHg<\/p>\n
Tr\u1ebb 2 \u2013 10 tu\u1ed5i 3 \u2013 7mmHg<\/p>\n
Tr\u1ebb < 2 tu\u1ed5i 1,5 \u2013 6mmHg<\/p>\n
\u00c1p l\u1ef1c trong s\u1ecd > 50mmHg: m\u00e1u kh\u00f4ng t\u1edbi n\u00e3o \u0111\u01b0\u1ee3c s\u1ebd ho\u1ea1i t\u1eed n\u00e3o.<\/p>\n
Theo d\u00f5i th\u01b0\u1eddng xuy\u00ean \u00e1p l\u1ef1c trong s\u1ecd \u0111\u00e3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng \u1edf h\u1ea7u h\u1ebft c\u00e1c trung t\u00e2m<\/p>\n
Ngo\u1ea1i th\u1ea7n kinh tr\u00ean Th\u1ebf gi\u1edbi, k\u1ec3 c\u1ea3 \u1edf c\u00e1c n\u01b0\u1edbc kinh t\u1ebf ch\u01b0a ph\u00e1t tri\u1ec3n. ICP monitoring<\/p>\n
c\u00f3 gi\u00e1 tr\u1ecb r\u1ea5t quan tr\u1ecdng trong vi\u1ec7c theo d\u00f5i, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh nh\u00e2n ch\u1ea5n<\/p>\n
th\u01b0\u01a1ng s\u1ecd n\u00e3o n\u1eb7ng. Th\u00ed d\u1ee5: s\u1ef1 th\u1ec3 hi\u1ec7n c\u00e1c s\u00f3ng b\u00e1o tr\u01b0\u1edbc t\u1ee5t n\u00e3o tr\u00ean m\u00e0n h\u00ecnh, gi\u00fap<\/p>\n
\u00edch cho vi\u1ec7c \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 h\u01a1n.<\/p>\n
3.8. CH\u1eccC D\u00d2 D\u01af\u1edaI M\u00c0NG C\u1ee8NG<\/p>\n
\uf02d \u00c1p d\u1ee5ng \u1edf tu\u1ed5i nh\u0169 nhi, c\u00f2n th\u00f3p b\u1ecb ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o nghi c\u00f3 m\u00e1u t\u1ee5 \u1edf d\u01b0\u1edbi m\u00e0ng<\/p>\n
\uf02d V\u1ecb tr\u00ed ch\u1ecdc: T\u1ea1i g\u00f3c hai b\u00ean c\u1ee7a th\u00f3p tr\u01b0\u1edbc (c\u00e1ch \u0111\u01b0\u1eddng gi\u1eefa 2 cm).<\/p>\n
III.9. CH\u1eccC T\u1ee6Y S\u1ed0NG<\/p>\n
Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh trong t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd d\u00f9ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n: vi\u00eam m\u00e0ng n\u00e3o, xuy\u1ebft<\/p>\n
huy\u1ebft d\u01b0\u1edbi m\u00e0ng nh\u1ec7n.<\/p>\n
III.10. \u0110I\u1ec6N N\u00c3O \u0110\u1ed2: \u00cdt l\u00e0m trong c\u1ea5p c\u1ee9u ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o.<\/p>\n
IV. C\u00c1C TH\u01af\u01a0NG T\u1ed4N TH\u01af\u1edcNG G\u1eb6P<\/p>\n
4.1. DA \u0110\u1ea6U<\/p>\n
\uf02d S\u01b0ng b\u1ea7m da \u0111\u1ea7u, mu\u1ed1n th\u1ea5y \u0111\u01b0\u1ee3c \u0111\u00f4i khi c\u1ea7n ph\u1ea3i c\u1ea1o t\u00f3c b\u1ec7nh nh\u00e2n, c\u00f3 th\u1ec3 n\u1ee9t s\u1ecd<\/p>\n
ngay ph\u00eda da s\u01b0ng b\u1ea7m.<\/p>\n
Khi c\u00f3 v\u1ee1 x\u01b0\u01a1ng \u0111\u00e1, v\u00f9ng da sau tai th\u01b0\u1eddng s\u01b0ng b\u1ea7m, \u0111\u00e2y l\u00e0 d\u1ea5u hi\u1ec7u BATTLE.<\/p>\n
\uf02d T\u1ee5 m\u00e1u d\u01b0\u1edbi da \u0111\u1ea7u: c\u00f3 hai lo\u1ea1i:<\/p>\n
+ T\u1ee5 m\u00e1u d\u01b0\u1edbi m\u00e0ng x\u01b0\u01a1ng: K\u00edch th\u00edch gi\u1edbi h\u1ea1n b\u1edfi c\u00e1c \u0111\u01b0\u1eddng kh\u1edbp s\u1ecd.<\/p>\n
+ T\u1ee5 m\u00e1u d\u01b0\u1edbi gal\u00e9a: th\u01b0\u1eddng lan r\u1ed9ng d\u01b0\u1edbi da \u0111\u1ea7u.<\/p>\n
M\u00e1u t\u1ee5 d\u01b0\u1edbi da \u0111\u1ea7u \u1edf c\u1ea3 hai lo\u1ea1i tr\u00ean th\u01b0\u1eddng \u0111\u01b0\u1ee3c c\u01a1 th\u1ec3 h\u1ea5p th\u1ee5 r\u1ea5t t\u1ed1t, kh\u00f4ng<\/p>\n
n\u00ean ch\u1ecdc h\u00fat v\u00ec d\u1ec5 g\u00e2y ra nhi\u1ec5m tr\u00f9ng, d\u1eabn t\u1edbi t\u1ee5 m\u1ee7 d\u01b0\u1edbi da \u0111\u1ea7u, vi\u00eam x\u01b0\u01a1ng s\u1ecd, \u00e1p xe<\/p>\n
\uf02d R\u00e1ch da \u0111\u1ea7u: L\u00e0 th\u01b0\u01a1ng t\u1ed5n th\u01b0\u1eddng g\u1eb7p trong ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o, c\u1ea7n c\u1ea1o r\u1ed9ng t\u00f3c<\/p>\n
quanh v\u1ebft th\u01b0\u01a1ng \u0111\u1ec3 th\u00e1m s\u00e1t xem c\u00e1c th\u01b0\u01a1ng t\u1ed5n k\u00e8m theo nh\u01b0; b\u1ec3 l\u00fan s\u1ecd, d\u00f2 d\u1ecbch n\u00e3o,<\/p>\n
l\u1ed3i m\u00f4 n\u00e3o qua ch\u1ed7 r\u00e1ch da.<\/p>\n
4.2. N\u1ee8T S\u1ecc \u0110\u01af\u1edcNG TH\u1eb2NG: N\u00ean \u0111\u1ec3 \u00fd xem \u0111\u01b0\u1eddng n\u1ee9t s\u1ecd c\u00f3 \u0111i ngang.<\/p>\n
\uf02d C\u00e1c m\u1ea1ch m\u00e1u l\u1edbn d\u1ec5 g\u00e2y ra m\u00e1u t\u1ee5 ngo\u00e0i m\u00e0ng c\u1ee9ng nh\u01b0:<\/p>\n
+ V\u00f9ng th\u00e1i d\u01b0\u01a1ng: \u0111\u01b0\u1eddng n\u1ee9t s\u1ecd c\u00f3 th\u1ec3 g\u00e2y ra \u0111\u1ee9t \u0111\u1ed9ng m\u1ea1ch m\u00e0ng n\u00e3o gi\u1eefa.<\/p>\n
+ V\u00f9ng \u0111\u1ec9nh gi\u1eefa hay ch\u1ea9m c\u00f3 th\u1ec3 l\u00e0m r\u00e1ch xoang t\u0129nh m\u1ea1ch.<\/p>\n
\uf02d Xoang tr\u00e1n: C\u00f3 th\u1ec3 g\u00e2y nhi\u1ec5m tr\u00f9ng s\u1ecd n\u00e3o, d\u00f9 l\u00e0 ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o k\u00edn.<\/p>\n
4.2.2. N\u1ee9t s\u1ecd \u0111\u01b0\u1eddng th\u1eb3ng c\u00f3 h\u1edf: Khi \u0111\u01b0\u1eddng n\u1ee9t r\u1ed9ng qu\u00e1 3mm, x\u1ea3y ra nhi\u1ec1u \u1edf tu\u1ed5i<\/p>\n
nh\u0169 nhi, c\u00f3 th\u1ec3 l\u00e0m r\u00e1ch m\u00e0ng c\u1ee9ng g\u00e2y ra v\u1ee1 s\u1ecd ti\u1ebfn tri\u1ec3n.<\/p>\n
4.2.3. V\u1ee1 s\u1ecd ti\u1ebfn tri\u1ec3n (Growing fracture): X\u1ea3y ra nhi\u1ec1u \u1edf tu\u1ed5i nh\u0169 nhi, l\u00e0m m\u00f4 n\u00e3o<\/p>\n
tho\u00e1t v\u1ecb qua khe n\u1ee9t s\u1ecd, g\u00e2y ra di ch\u1ee9ng teo n\u00e3o, r\u1ed7ng n\u00e3o (Porencephalic Cavitation).<\/p>\n
Kh\u00e1m l\u00e2m s\u00e0ng th\u01b0\u1eddng th\u1ea5y m\u1ed9t kh\u1ed1i u d\u01b0\u1edbi da \u0111\u1ea7u, \u0111\u1eb7c bi\u1ec7t theo nh\u1ecbp \u0111\u1eadp c\u1ee7a n\u00e3o.<\/p>\n
Kh\u00f4ng n\u00ean d\u00f9ng kim ch\u1ecdc h\u00fat v\u00ec d\u1ec5 g\u00e2y nhi\u1ec5m tr\u00f9ng.<\/p>\n
V\u1ee1 s\u1ecd ti\u1ebfn tri\u1ec3n l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd c\u1ea7n c\u1ea5p c\u1ee9u \u0111\u1ec3 tr\u00e1nh c\u00e1c d\u01b0 ch\u1ee9ng v\u1eeba k\u1ec3 v\u00e0 \u0111\u1ec3<\/p>\n
tr\u00e1nh s\u1ef1 x\u00e9 r\u1ed9ng m\u00e0ng c\u1ee9ng do x\u01b0\u01a1ng ti\u1ebfp t\u1ee5c b\u1ecb to\u00e1c r\u1ed9ng.<\/p>\n
4.2.4. V\u1ee1 x\u01b0\u01a1ng tr\u00e1n cung m\u1eaft, tr\u1ea7n h\u1ed1c m\u1eaft: m\u00e1u s\u1ebd ch\u1ea3y ng\u1ea5m v\u00e0o m\u00f4 m\u1ee1 \u1edf h\u1ed1c<\/p>\n
m\u1eaft, g\u00e2y ra s\u1ef1 b\u1ea7m hai mi m\u1eaft: d\u1ea5u hi\u1ec7u k\u00ednh r\u00e2m.<\/p>\n
4.2.5. V\u1ee1 s\u00e0n s\u1ecd: C\u00f3 th\u1ec3 l\u00e0m d\u00f2 d\u1ecbch n\u00e3o t\u1ee7y \u1edf:<\/p>\n
+ M\u0169i: Ch\u1ee5p X_ Quang c\u00f3 th\u1ec3 th\u1ea5y h\u01a1i trong h\u1ed9p s\u1ecd.<\/p>\n
+ Tai: Kh\u00e1m th\u1ea5y c\u00f3 d\u1ea5u Battle \u1edf v\u00f9ng x\u01b0\u01a1ng ch\u0169m v\u00e0 m\u00e0ng nh\u0129 b\u1ecb r\u00e1ch.<\/p>\n
4.3. M\u00c1U T\u1ee4 TRONG S\u1ecc<\/p>\n
4.3.1. M\u00e1u t\u1ee5 ngo\u00e0i m\u00e0ng c\u1ee9ng<\/p>\n
\uf02b Hi\u1ebfm g\u1eb7p \u1edf tu\u1ed5i nh\u0169 nhi.<\/p>\n
\uf02b Ngu\u1ed3n ch\u1ea3y m\u00e1u: \u0110\u1ed9ng m\u1ea1ch m\u00e0ng n\u00e3o, xoang t\u0129nh m\u1ea1ch d\u1ecdc tr\u00ean, xoang t\u0129nh<\/p>\n
m\u1ea1ch ngang ho\u1eb7c t\u1eeb x\u01b0\u01a1ng n\u1ee9t.<\/p>\n
\uf02b B\u1ec7nh nh\u00e2n th\u01b0\u1eddng c\u00f3 kho\u1ea3ng t\u1ec9nh t\u1eeb v\u00e0i gi\u1edd \u0111\u1ebfn 24 gi\u1edd, c\u00f3 v\u00e0i tr\u01b0\u1eddng h\u1ee3p kho\u1ea3ng<\/p>\n
t\u1ec9nh k\u00e9o d\u00e0i l\u00e2u h\u01a1n.<\/p>\n
\uf02b Tri\u1ec7u ch\u1ee9ng: b\u1ec7nh nh\u00e2n th\u01b0\u1eddng c\u00f3 d\u1ea5u hi\u1ec7u nh\u1ee9c \u0111\u1ea7u, \u00f3i, \u0111\u1ed9ng kinh, d\u1ea5u hi\u1ec7u th\u1ea7n<\/p>\n
kinh khu tr\u00fa. \u1ede tr\u1ebb em d\u1ea5u hi\u1ec7u m\u1ea5t m\u00e1u th\u01b0\u1eddng c\u00f3.<\/p>\n
\uf02b X_Quang s\u1ecd: 75% tr\u01b0\u1eddng h\u1ee3p c\u00f3 n\u1ee9t s\u1ecd.<\/p>\n
\uf02b Ch\u1ea9n \u0111o\u00e1n c\u01a1 b\u1ea3n nh\u1ea5t l\u00e0 CT Scan \u0111\u1ea7u.<\/p>\n
T\u1ec9 l\u1ec7 m\u00e1u t\u1ee5 ngo\u00e0i m\u00e0ng c\u1ee9ng s\u1ecd v\u1edbi ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o kh\u00f4ng cao nh\u01b0ng c\u1ea7n bi\u1ebft<\/p>\n
ph\u00e1t hi\u1ec7n c\u00e1c m\u00e1u t\u1ee5 ngo\u00e0i m\u00e0ng c\u1ee9ng trong h\u1ed9p s\u1ecd v\u00ec m\u1ed5 c\u00f3 th\u1ec3 c\u1ee9u s\u1ed1ng b\u1ec7nh nh\u00e2n v\u00e0<\/p>\n
\u00edt \u0111\u1ec3 l\u1ea1i di ch\u1ee9ng.<\/p>\n
4.3.2. M\u00e1u t\u1ee5 d\u01b0\u1edbi m\u00e0ng c\u1ee9ng: C\u00f3 hai lo\u1ea1i c\u1ea5p di\u1ec5n v\u00e0 b\u00e1n c\u1ea5p:<\/p>\n
a. M\u00e1u t\u1ee5 d\u01b0\u1edbi m\u00e0ng c\u1ee9ng c\u1ea5p<\/p>\n
\uf02d Tr\u1ebb s\u01a1 sinh: Th\u01b0\u1eddng do tai bi\u1ebfn l\u00fac sinh, b\u00e9 c\u00f3 tri\u1ec7u ch\u1ee9ng th\u1edf kh\u00f3, gi\u00e3n \u0111\u1ed3ng t\u1eed,<\/p>\n
th\u00f3p tr\u01b0\u1edbc ph\u1ed3ng, xuy\u1ebft huy\u1ebft v\u00f5ng m\u1ea1c. Ngu\u1ed3n g\u1ed1c ch\u1ea3y m\u00e1u: R\u00e1ch \u0111\u1ed9ng m\u1ea1ch v\u1ecf n\u00e3o.<\/p>\n
Ch\u1ea9n \u0111o\u00e1n: Ch\u1ecdc th\u00f3p tr\u01b0\u1edbc th\u1ea5y d\u1ecbch n\u00e3o t\u1ee7y m\u00e0u h\u1ed3ng ch\u1ea3y ra, kh\u00f4ng \u0111\u00f4ng.<\/p>\n
\uf02d Ng\u01b0\u1eddi l\u1edbn: Ngu\u1ed3n ch\u1ea3y m\u00e1u: Do r\u00e1ch t\u0129nh m\u1ea1ch n\u1ed1i v\u1ecf n\u00e3o v\u00e0 xoang t\u0129nh m\u1ea1ch<\/p>\n
Tri\u1ec7u ch\u1ee9ng: tri gi\u00e1c gi\u1ea3m, d\u1ea5u th\u1ea7n kinh khu tr\u00fa. Ch\u1ea9n \u0111o\u00e1n: L\u00e0m CT Scan n\u00e3o th\u1ea5y<\/p>\n
l\u1edbp m\u00e1u t\u1ee5 lan t\u1ecfa, n\u1ebfu b\u1ec1 d\u00e0y m\u00e1u t\u1ee5 d\u01b0\u1edbi 5mm th\u01b0\u1eddng tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng \u00edt c\u00f3. D\u1ef1<\/p>\n
h\u1eadu: x\u1ea5u do k\u00e8m d\u1eadp n\u00e3o.<\/p>\n
b. M\u00e1u t\u1ee5 d\u01b0\u1edbi m\u00e0ng c\u1ee9ng b\u00e1n c\u1ea5p: Th\u01b0\u1eddng x\u1ea3y ra sau 7 \u2013 10 ng\u00e0y sau khi ch\u1ea5n<\/p>\n
th\u01b0\u01a1ng s\u1ecd n\u00e3o, (th\u1eddi gian n\u00e0y t\u00f9y quan ni\u1ec7m m\u1ed7i t\u00e1c gi\u1ea3), khi m\u1ed5 th\u1ea5y \u1ed5 m\u00e1u t\u1ee5 \u0111\u01b0\u1ee3c bao<\/p>\n
b\u1eb1ng m\u1ed9t m\u00e0ng gi\u1ea3 fibrin.<\/p>\n
\uf02d B\u1ec7nh nh\u00e2n \u0111\u1ebfn kh\u00e1m:<\/p>\n
\uf02b H\u1ecfi ti\u1ec1n c\u0103n b\u1ea3n ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o.<\/p>\n
\uf02b Kh\u00e1m c\u00f3: D\u1ea5u hi\u1ec7u t\u0103ng \u00e1p l\u1ef1c trong s\u1ecd, \u0111\u1eb7c bi\u1ec7t d\u1ea5u ph\u00f9 gai th\u1ecb sau ch\u1ea5n th\u01b0\u01a1ng<\/p>\n
s\u1ecd n\u00e3o; d\u1ea5u hi\u1ec7u th\u1ea7n kinh khu tr\u00fa t\u00f9y v\u1ecb tr\u00ed m\u00e1u t\u1ee5 ch\u00e8n \u00e9p.<\/p>\n
\uf02d C\u1eadn l\u00e2m s\u00e0ng:<\/p>\n
\uf02b X_ Quang s\u1ecd th\u01b0\u1eddng: c\u00f3 h\u00f3a v\u00f4i \u1ed5 m\u00e1u t\u1ee5 m\u00e3n t\u00ednh (hi\u1ebfm g\u1eb7p).<\/p>\n
\uf02b M\u1ea1ch n\u00e3o \u0111\u1ed3: Kho\u1ea3ng v\u00f4 m\u1ea1ch h\u00ecnh th\u1ea5u k\u00ednh.<\/p>\n
\uf02b C.T n\u00e3o: ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c nh\u1ea5t v\u1edbi h\u00ecnh \u1ea3nh th\u1ea5u k\u00ednh.<\/p>\n
4.3.3. M\u00e1u t\u1ee5 trong n\u00e3o<\/p>\n
\uf02d Do \u0111\u1ee9t m\u1ea1ch m\u00e1u d\u01b0\u1edbi v\u1ecf n\u00e3o<\/p>\n
\uf02d X\u1ea3y ra nhi\u1ec1u \u1edf th\u00f9y tr\u00e1n v\u00e0 th\u00f9y th\u00e1i d\u01b0\u01a1ng do c\u01a1 ch\u1ebf ch\u1ea5n \u0111\u1ed9ng d\u1ed9i (contre coup).<\/p>\n
\uf02d L\u00e2m s\u00e0ng: nh\u01b0 m\u00e1u t\u1ee5 ngo\u00e0i m\u00e0ng c\u1ee9ng v\u00e0 d\u01b0\u1edbi m\u00e0ng c\u1ee9ng.<\/p>\n
\uf02d Ch\u1ea9n \u0111o\u00e1n: CT Scan n\u00e3o<\/p>\n
\uf02d M\u1ed5 khi tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng ti\u1ebfn tri\u1ec3n x\u1ea5u.<\/p>\n
4.3.4. T\u1ee5 d\u1ecbch n\u00e3o t\u1ee7y<\/p>\n
\uf02d Do r\u00e1ch m\u00e0ng nh\u1ec7n: Van m\u1ed9t chi\u1ec1u, d\u1ecbch n\u00e3o t\u1ee7y tho\u00e1t ra ngo\u00e0i m\u00e0ng nh\u1ec7n \u0111\u1ecdng l\u1ea1i<\/p>\n
gi\u1eefa m\u00e0ng nh\u1ec7n v\u00e0 m\u00e0ng c\u1ee9ng m\u00e0 kh\u00f4ng ch\u1ea3y tr\u1edf l\u1ea1i h\u1ec7 th\u1ed1ng d\u1ecbch n\u00e3o t\u1ee7y.<\/p>\n
\uf02d Th\u01b0\u1ee1ng x\u1ea3y ra nhi\u1ec1u ng\u00e0y ho\u1eb7c nhi\u1ec1u tu\u1ea7n sau ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o.<\/p>\n
\uf02d Tri\u1ec7u ch\u1ee9ng nh\u01b0 m\u00e1u t\u1ee5 d\u01b0\u1edbi m\u00e0ng c\u1ee9ng.<\/p>\n
4.4. TH\u01af\u01a0NG T\u1ed4N N\u00c3O<\/p>\n
4.4.1. Ch\u1ea5n \u0111\u1ed9ng n\u00e3o (Concussion)<\/p>\n
\uf02d R\u1ed1i lo\u1ea1n t\u1ea1m th\u1eddi c\u00e1c ch\u1ee9c n\u0103ng c\u00e1c m\u00f4 th\u1ea7n kinh.<\/p>\n
\uf02d L\u00e2m s\u00e0ng: R\u1ed1i lo\u1ea1n tri gi\u00e1c ng\u1eafn, t\u1ec9nh d\u1eady b\u1ec7nh nh\u00e2n qu\u00ean c\u00e1c s\u1ef1 vi\u1ec7c \u0111\u00e3 x\u1ea3y ra.<\/p>\n
\u1ede tr\u1ebb nh\u1ecf: cho\u00e1ng v\u00e1ng, \u00f3i, xanh xao. Tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng ng\u01b0\u1eddi m\u1ec1m nh\u0169n, \u0111\u1ed3ng t\u1eed<\/p>\n
gi\u00e3n h\u1ebft ph\u1ea3n x\u1ea1, ng\u01b0ng th\u1edf t\u1ea1m th\u1eddi.<\/p>\n
80% \u2013 90% ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o n\u1eb7ng c\u00f3 d\u1eadp n\u00e3o k\u00e8m xu\u1ea5t huy\u1ebft ho\u1ea1i t\u1eed, r\u00e1ch m\u00f4<\/p>\n
n\u00e3o, ph\u00f9 n\u00e3o th\u01b0\u1eddng x\u1ea3y ra \u1edf th\u00f9y tr\u00e1n, th\u00f9y th\u00e1i d\u01b0\u01a1ng do c\u01a1 ch\u1ebf ch\u1ea5n \u0111\u1ed9ng d\u1ed9i.<\/p>\n
\uf02d C\u1ea7n theo d\u00f5i \u0111\u1ed9 h\u00f4n m\u00ea.<\/p>\n
\uf02d H\u1ed9i ch\u1ee9ng th\u00f9y th\u00e1i d\u01b0\u01a1ng: tri gi\u00e1c, li\u1ec7t n\u1eeda ng\u01b0\u1eddi, gi\u00e3n \u0111\u1ed3ng t\u1eed.<\/p>\n
\uf02d R\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p.<\/p>\n
\uf02d Nhi\u1ec7t \u0111\u1ed9 t\u0103ng.<\/p>\n
\uf02d Lo\u00e9t d\u1ea1 d\u00e0y: \u1ede tr\u01b0\u1eddng h\u1ee3p d\u1eadp n\u00e3o k\u00e8m ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o<\/p>\n","protected":false},"excerpt":{"rendered":"
NGO\u1ea0I C\u01a0 S\u1ede: KH\u00c1M CH\u1ea4N TH\u01af\u01a0NG S\u1ecc N\u00c3O link down full b\u00e0i gi\u1ea3ng :http:\/\/adf.ly\/1ZWIR3 KH\u00c1M CH\u1ea4N TH\u01af\u01a0NG S\u1ecc N\u00c3O A. H\u00c0NH CH\u00cdNH 1. T\u00ean m\u00f4n h\u1ecdc: Ngo\u1ea1i b\u1ec7nh l\u00fd 2. T\u00ean b\u00e0i gi\u1ea3ng: Kh\u00e1m ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o 3. H\u00ecnh th\u1ee9c gi\u1ea3ng v\u00e0 b\u00e0i gi\u1ea3ng: L\u00fd thuy\u1ebft 4. \u0110\u1ed1i t\u01b0\u1ee3ng: Y 3, CT2 5. Th\u1eddi …<\/p>\n","protected":false},"author":10,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[57,58],"tags":[],"class_list":["post-2271","post","type-post","status-publish","format-standard","","category-ngoai-khoa","category-ngoai-co-so"],"_links":{"self":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2271","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/users\/10"}],"replies":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/comments?post=2271"}],"version-history":[{"count":2,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2271\/revisions"}],"predecessor-version":[{"id":2297,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2271\/revisions\/2297"}],"wp:attachment":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media?parent=2271"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/categories?post=2271"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/tags?post=2271"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}